DOCSLIB.ORG

Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation Jemds.com Original Research Article Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation Sathya Narayanan Karunanithi1, Geeta Bhandari2, Kedar Singh Shahi3, Aditya Kumar Chauhan4, Pooja Gautam5 1Department of Anaesthesiology, Critical Care, Pain and Palliative Medicine Government Medical College, Haldwani, Uttarakhand, India. 2 Department of Anaesthesiology, Critical Care, Pain and Palliative Medicine Government Medical College, Haldwani, Uttarakhand, India. 3Department of Surgery, Government Medical College, Haldwani, Uttarakhand, India. 4Department of Anaesthesiology, Critical Care, Pain and Palliative Medicine Government Medical College, Haldwani, Uttarakhand, India. 5Department of Anaesthesiology, Critical Care, Pain and Palliative Medicine Government Medical College, Haldwani, Uttarakhand, India. ABSTRACT BACKGROUND Not many studies have compared more than two drugs in attenuating pressor Corresponding Author: responses to laryngoscopy and intubation. This study compares four groups of Dr. Geeta Bhandari, considerable size. The present study compared intravenous esmolol, diltiazem, and Professor and HOD, Department of Anaesthesiology, lignocaine, for their efficacy to abate pressure response to laryngoscopy and Critical Care, Pain and Palliative Medicine, intubation. Government Medical College, Haldwani-263139, Uttarakhand, India. METHODS E-mail: [email protected] This is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing DOI: 10.14260/jemds/2020/447 elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects How to Cite This Article: were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), Karunanithi SN, Bhandari G, Shahi KS, et esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; al. Comparative study of IV esmolol, IV each group had 55 patients. Haemodynamic parameters were recorded at baseline, diltiazem, and IV lignocaine hydrochloride after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes in attenuating pressure response to after intubation. Data entry and analysis were performed using MS Excel and SPSS- laryngoscopy and intubation. J. Evolution PC-17 version, respectively. One-way ANOVA and the chi-square test were used to Med. Dent. Sci. 2020;9(29):2053-2057, evaluate the difference. P < 0.05 was considered significant. DOI: 10.14260/jemds/2020/447 Submission 30-04-2020, RESULTS Peer Review 14-06-2020, A maximum increase in haemodynamic parameters occurred immediately after Acceptance 20-06-2020, intubation. The increase in heart rate and rate pressure product were significantly Published 20-07-2020. lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). Copyright © 2020 JEMDS. This is an open access article distributed under Creative Commons Attribution License [Attribution CONCLUSIONS 4.0 International (CC BY 4.0)] Haemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine. KEY WORDS Diltiazem, Esmolol, Lignocaine, Haemodynamic Response, Intubation, Laryngoscopy, Normal Saline, Intravenous J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 9/ Issue 29/ July 20, 2020 Page 2053 Jemds.com Original Research Article BACKGROUND The drug should be used with caution in patients with impaired renal or hepatic function.[15-17] Lidocaine is [2-(Diethylamino)-N-2, 6-Dimethyl phenyl Endotracheal intubation has become an integral part of acetamide)] an amide group of local anaesthetic agent. It is airway management since its description in 1921 by metabolized by oxidases and amidases from microsomes of [1] Rowbotham and Magill. Laryngeal, tracheal, and bronchial liver and the metabolites are excreted in the urine, hastened receptors are stimulated by mechanical and chemical when the urine is acidic.[13] [2] irritants during laryngoscopy, intubation, and extubation. Only a few studies with compact sample sizes comparing Surges in blood pressure and heart rate (HR) due to reflex the efficacy of intravenous (IV) lidocaine, esmolol, and sympathetic and vagal discharges after laryngotracheal diltiazem for abolishing the pressure response have been stimulation often increase the plasma norepinephrine conducted to the best of our knowledge. Hence, the present [3] concentration. This change is of limited significance in study with a substantial sample size was planned to compare healthy patients but may prove fatal in patients with the aforesaid. [4] cardiovascular instability, causing sudden deaths. These cardiovascular responses may have serious consequences, including myocardial ischemia, dysrhythmias, METHODS pulmonary oedema, sudden left ventricular failure, cerebrovascular haemorrhage and at times even cardiac arrest. Hence, abating the pressure response to laryngoscopy The present study was conducted for 15 months from March and intubation has become one of the most researched topics 2018 to May 2019 in our hospital after receiving an approval in the field of anaesthesiology. These changes are tolerated from the institutional ethics committee. This prospective, quite well by healthy patients, however patients suffering randomized, double-blind, controlled clinical study from coronary artery disease, hypertension, valvular heart comprised 220 normotensive consented male and female disease, stroke, intracranial lesions, and penetrating eye patients aged 18–60 years. injuries are not able to withstand them. In these patients, The sample size is calculated by taking mean of the pulse myocardial reserve is decreased, and tachycardia associated rate after the drug administration from the following studies with laryngoscopy and intubation cause myocardial using WIN PEPI software. [5] ischemia. 1. The mean of pulse rate in the diltiazem group was taken Numerous attempts have been made to modify as 94 after drug administration.[18] haemodynamic responses, including the use of 2. The mean of pulse rate in the lignocaine group was taken premedication; deep anaesthesia; topical anaesthesia; as 81.76 and that of esmolol as 82.96 after drug ganglion blockers and beta blockers,[5] antihypertensive administration.[19] agents such as phentolamine,[6] adjuvants like gabapentin[7] and pregabalin,[8] and vasodilators such as magnesium, Sample size has been calculated by using power analysis Sodium nitroprusside and nitroglycerine[9] are effective in & alpha error of 0.05 and the power of the study as 80%. modifying the responses but require continuous monitoring. They were scheduled for an elective surgery under Various drug regimens and modalities, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel general anaesthesia with endotracheal intubation of ASA blockers, and vasodilators, have been commonly used for physical status I and II. Patients with ASA grade III or more; blunting the stress response to laryngoscopy and receiving beta blockers or calcium channel blockers; with intubation.[10-12] However, none of them have proved to be significant hepatorenal disease, uncontrolled hypertension, ideal due to their limitations and side effects. Thus, the search diabetes, and significant respiratory or cardiovascular for an ideal agent to negate the haemodynamic responses of diseases; posted for emergency surgeries; undergoing laryngoscopy and intubation has never ceased. difficult tracheal intubation; and who are underweight or Esmolol, [methyl 3-{4-(2–hydroxyl–3)-isopropylamino obese were excluded from the study. propoxyl] phenyl} proprionate HCl] is a cardioselective water After a meticulous preanaesthetic examination, the soluble ultrashort acting α-1 adrenergic receptor antagonist patients were randomly divided into Groups D, E, L, and N of that can be administered only intravenously. 55 each by using a closed envelope technique. Esmolol is rapidly hydrolysed by cytoplasmic esterases in The name of 4 groups of drugs were equally written in red blood cells and hence has a short elimination period of 220 opaque envelopes and sealed. The sealed envelopes were approximately 9 min., a distribution half-life of 2 min and a placed in a container and shuffled. After shuffling, the sealed peak haemodynamic effect within 6 to 10 min. of envelopes were numbered from 1 to 220 in sequence. Sealed administration. Its metabolism is not influenced by renal or envelope were opened in sequence corresponding to the hepatic function and less than 1% excreted in urine as number of the patient. Double blinding was done to avoid any [13] unchanged drug. bias. Esmolol is a striking option because of its cardio- Groups D, E, and L received an injection of diltiazem (0.2 selectivity and ultra-short duration of action, but it can only mg/Kg), esmolol (2 mg/Kg), and lignocaine (1.5 mg/Kg), be administered intravenously.[14] respectively, whereas Group C received 3 mL normal saline. Calcium channel blockers are also preferred because All the groups received the aforementioned as a bolus myocardial depression produced by them is minimized by intravenously 2 min before laryngoscopy and intubation. reduction in afterload so that cardiac
Load more

Recommended publications
  • Use of Intravenous Esmolol to Predict Efficacy of Oral Beta-Adrenergic Blocker Therapy in Patients with Neurocardiogenic Syncope
    402 JACC Vol. 19, No. 2 February 1992:402-8 REPORTS ON THERAPY Use of Intravenous Esmolol to Predict Efficacy of Oral Beta­ Adrenergic Blocker Therapy in Patients With Neurocardiogenic Syncope JASBIR S. SRA, MD, VISHNUBHAKTA S. MURTHY, MD, PHD, MOHAMMAD R. JAZAYERI, MD, FACC, YUE-HUA SHEN, MD, PAUL J. TROUP, MD, FACC, BOAZ AVITALL, MD, PHD, MASOOD AKHTAR, MD, FACC Milwaukee, Wisconsin The usefulness of esmolol in predicting the efficacy of treatment Irrespective of their response to esmolol infusion, all patients with an oral beta-adrenergic blocking agent was evaluated in 27 had a follow-up tilt test with oral metoprolol after an interval of consecutive patients with neurocardiogenic syncope. Seventeen ~5 half-lives of the drug. All 16 patients (100%) with a negative patients had a positive head-up tilt test response at baseline and 10 tilt test response during esmolol infusion had a negative tilt test patients required intravenous isoproterenol for provocation of response with oral metoprolol. Of the 11 patients with a positive hypotension. All patients were then given a continuous esmolol tilt test response during esmolol infusion, 10 (90%) continued to infusion (500 JLg/kg per min loading dose for 3 min followed by have a positive response with oral metoprolol. 300 Jlg/kg per min maintenance dose) and rechallenged with a It is concluded that in the electrophysiology laboratory, es­ head-up tilt test at baseline or with isoproterenol. molol can accurately predict the outcome of a head-up tilt Of the 17 patients with a positive baseline tilt test response, 11 response to oral metoprolol.
    [Show full text]
  • Esmolol Hydrochloride 10 Mg/Ml Solution for Injection Esmolol Hydrochloride
    Package leaflet: Information for the patient Esmolol hydrochloride 10 mg/ml solution for injection Esmolol hydrochloride Read all of this leaflet carefully before you start using this medicine because it contains important information for you. – Keep this leaflet. You may need to read it again. – If you have any further questions, ask your doctor or nurse. – This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. – If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet: 1. What Esmolol hydrochloride 10 mg/ml solution for injection is and what it is used for 2. What you need to know before you use Esmolol hydrochloride 10 mg/ml solution for injection 3. How to use Esmolol hydrochloride 10 mg/ml solution for injection 4. Possible side effects 5. How to store Esmolol hydrochloride 10 mg/ml solution for injection 6. Contents of the pack and other information 1. What Esmolol hydrochloride 10 mg/ml chlor promazine, used to treat mental dis - solution for injection is and what it is orders) used for – Clozapine which is used to treat mental Esmolol hydrochloride 10 mg/ml belongs to the disorders group of beta-blockers. These medicines slow – Epinephrine, which is used to treat allergic down the heartbeat and reduce blood pressure. reactions – Medicines used to treat asthma Esmolol hydrochloride 10 mg/ml is used for – Medicines used to treat colds or a blocked short-term treatment if your heart beats too nose, called nasal “decongestants” fast.
    [Show full text]
  • Keeping up with the Pace of Antiarrhythmic Drugs ANNMARIE PALATNIK, APN,BC, MSN Coordinator of Continuing Education • Virtua Health • Marlton, N.J
    D rug File Keeping up with the pace of antiarrhythmic drugs ANNMARIE PALATNIK, APN,BC, MSN Coordinator of Continuing Education • Virtua Health • Marlton, N.J. HAVE YOU NOTICED how challenging it is to Conducting impulses keep pace with the The conduction system of the heart, shown below, begins with the heart’s natural pacemaker, the changing beat of phar- sinoatrial (SA) node. When an impulse leaves the SA node, it travels through the atria along macology? Just as you Bachmann’s bundle and the internodal pathways on its way to the atrioventricular (AV) node. After learn the latest drugs the impulse passes through the AV node, it travels to the ventricles, first down the bundle of His, and classifications, new then along the bundle branches and, finally, down the Purkinje fibers. classes are developed and new drugs added to Bachmann’s bundle classes. Even drugs that have been on the mar- ket a long time can have dosing and indica- SA node tion changes. Antiarrhythmic Internodal tracts drugs, which restore Posterior (Thorel’s) normal rhythm and Middle (Wenckebach’s) conduction to the heart, Anterior are no exception. In this AV node article, I’ll bring you up-to-date on the Bundle of His antiarrhythmics now Right bundle branch available. Left bundle branch Class assignments Most antiarrhythmic drugs used to slow a rapid heart rate are classified according to the Vaughn Williams classification system Purkinje fibers (see Classifying Anti- arrhythmics the Vaughn Williams way). These drugs fall Class I into four general groups in this classification system Sodium channel blockers stop the flow of sodium into with each group having several subgroups.
    [Show full text]
  • Atrial Fibrillation in the Surgical Patient
    DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care practices based upon the available medical literature and clinical expertise at the time of development. They should not be considered to be accepted protocol or policy, nor are intended to replace clinical judgment or dictate care of individual patients. NEW ONSET ATRIAL FIBRILLATION IN THE SURGICAL PATIENT SUMMARY Atrial fibrillation is a common postoperative arrhythmia and can represent a major source of morbidity and mortality. Treatment of atrial fibrillation is directed at three main objectives: controlling the ventricular response, preventing thromboembolism, and maintaining sinus rhythm. Therapeutic decisions also hinge on patients’ hemodynamic stability. In patients who are hemodynamically unstable, direct current cardioversion is the first line therapy and pharmacotherapy should be used as adjunctive treatment. In patients who are hemodynamically stable, pharmacologic treatment including class II (beta-blockers), class III (amiodarone), or class IV (nondihydropyridine calcium channel blockers) agents are viable options. RECOMMENDATIONS Level 1 Beta-blockade (esmolol or metoprolol), nondihydropyridine calcium channel blockers (diltiazem or verapamil), and amiodarone are pharmacologic options to manage new onset atrial fibrillation (see table for dosing). Beta-blockers are the first line therapy for postoperative atrial fibrillation to achieve rapid ventricular rate control and conversion to sinus rhythm. Diltiazem is second line rate control agent when beta-blocker therapy has failed. Both therapies should be avoided in hypotensive patients. Amiodarone can provide both rate and rhythm control and is an alternative therapy to beta-blockade for postoperative atrial fibrillation especially when the patient is hemodynamically unstable or has a known ejection fraction of < 40%.
    [Show full text]
  • Marrakesh Agreement Establishing the World Trade Organization
    No. 31874 Multilateral Marrakesh Agreement establishing the World Trade Organ ization (with final act, annexes and protocol). Concluded at Marrakesh on 15 April 1994 Authentic texts: English, French and Spanish. Registered by the Director-General of the World Trade Organization, acting on behalf of the Parties, on 1 June 1995. Multilat ral Accord de Marrakech instituant l©Organisation mondiale du commerce (avec acte final, annexes et protocole). Conclu Marrakech le 15 avril 1994 Textes authentiques : anglais, français et espagnol. Enregistré par le Directeur général de l'Organisation mondiale du com merce, agissant au nom des Parties, le 1er juin 1995. Vol. 1867, 1-31874 4_________United Nations — Treaty Series • Nations Unies — Recueil des Traités 1995 Table of contents Table des matières Indice [Volume 1867] FINAL ACT EMBODYING THE RESULTS OF THE URUGUAY ROUND OF MULTILATERAL TRADE NEGOTIATIONS ACTE FINAL REPRENANT LES RESULTATS DES NEGOCIATIONS COMMERCIALES MULTILATERALES DU CYCLE D©URUGUAY ACTA FINAL EN QUE SE INCORPOR N LOS RESULTADOS DE LA RONDA URUGUAY DE NEGOCIACIONES COMERCIALES MULTILATERALES SIGNATURES - SIGNATURES - FIRMAS MINISTERIAL DECISIONS, DECLARATIONS AND UNDERSTANDING DECISIONS, DECLARATIONS ET MEMORANDUM D©ACCORD MINISTERIELS DECISIONES, DECLARACIONES Y ENTEND MIENTO MINISTERIALES MARRAKESH AGREEMENT ESTABLISHING THE WORLD TRADE ORGANIZATION ACCORD DE MARRAKECH INSTITUANT L©ORGANISATION MONDIALE DU COMMERCE ACUERDO DE MARRAKECH POR EL QUE SE ESTABLECE LA ORGANIZACI N MUND1AL DEL COMERCIO ANNEX 1 ANNEXE 1 ANEXO 1 ANNEX
    [Show full text]
  • Comparison of the Β-Adrenergic Receptor Antagonists Landiolol and Esmolol: Receptor Selectivity, Partial Agonism, and Pharmacoc
    1521-0103/359/1/73–81$25.00 http://dx.doi.org/10.1124/jpet.116.232884 THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS J Pharmacol Exp Ther 359:73–81, October 2016 Copyright ª 2016 by The American Society for Pharmacology and Experimental Therapeutics Comparison of the b-Adrenergic Receptor Antagonists Landiolol and Esmolol: Receptor Selectivity, Partial Agonism, and Pharmacochaperoning Actions Shahrooz Nasrollahi-Shirazi, Sonja Sucic, Qiong Yang, Michael Freissmuth, and Christian Nanoff Institute of Pharmacology, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria Received February 15, 2016; accepted July 18, 2016 Downloaded from ABSTRACT Blockage of b1-adrenergic receptors is one of the most effective was very low. Both landiolol and esmolol caused a very modest treatments in cardiovascular medicine. Esmolol was introduced rise in cAMP levels but a robust increase in the phosphorylation some three decades ago as a short-acting b1-selective antag- of extracellular signal regulated kinases 1 and 2, indicating that the onist. Landiolol is a more recent addition. Here we compared the two drugs exerted partial agonist activity with a signaling bias. If two compounds for their selectivity for b1-adrenergic receptors cells were incubated for $24 hours in the presence of $1 mM jpet.aspetjournals.org over b2-adrenergic receptors, partial agonistic activity, signaling esmolol, the levels of b1-adrenergic—but not of b2-adrenergic— bias, and pharmacochaperoning action by using human embry- receptors increased. This effect was contingent on export of onic kidney (HEK)293 cell lines, which heterologously express the b1-receptor from endoplasmic reticulum and was not seen each human receptor subtype.
    [Show full text]
  • Drugs That Affect the Cardiovascular System
    PharmacologyPharmacologyPharmacology DrugsDrugs thatthat AffectAffect thethe CardiovascularCardiovascular SystemSystem TopicsTopicsTopics •• Electrophysiology Electrophysiology •• Vaughn-Williams Vaughn-Williams classificationclassification •• Antihypertensives Antihypertensives •• Hemostatic Hemostatic agentsagents CardiacCardiacCardiac FunctionFunctionFunction •• Dependent Dependent uponupon –– Adequate Adequate amountsamounts ofof ATPATP –– Adequate Adequate amountsamounts ofof CaCa++++ –– Coordinated Coordinated electricalelectrical stimulusstimulus AdequateAdequateAdequate AmountsAmountsAmounts ofofof ATPATPATP •• Needed Needed to:to: –– Maintain Maintain electrochemicalelectrochemical gradientsgradients –– Propagate Propagate actionaction potentialspotentials –– Power Power musclemuscle contractioncontraction AdequateAdequateAdequate AmountsAmountsAmounts ofofof CalciumCalciumCalcium •• Calcium Calcium isis ‘glue’‘glue’ that that linkslinks electricalelectrical andand mechanicalmechanical events.events. CoordinatedCoordinatedCoordinated ElectricalElectricalElectrical StimulationStimulationStimulation •• Heart Heart capablecapable ofof automaticityautomaticity •• Two Two typestypes ofof myocardialmyocardial tissuetissue –– Contractile Contractile –– Conductive Conductive •• Impulses Impulses traveltravel throughthrough ‘action‘action potentialpotential superhighway’.superhighway’. A.P.A.P.A.P. SuperHighwaySuperHighwaySuperHighway •• Sinoatrial Sinoatrial node node •• Atrioventricular Atrioventricular nodenode •• Bundle Bundle ofof
    [Show full text]
  • SUPPLEMENTARY MATERIAL 1: Search Strategy
    SUPPLEMENTARY MATERIAL 1: Search Strategy Medline search strategy 1. exp basal ganglia hemorrhage/ or intracranial hemorrhages/ or cerebral hemorrhage/ or intracranial hemorrhage, hypertensive/ or cerebrovascular disorders/ 2. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracran$ or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli$ or putaminal or putamen or posterior fossa or hemispher$ or pon$ or lentiform$ or brainstem or cortic$ or cortex$ or subcortic$ or subcortex$) adj5 (h?emorrhag$ or h?ematoma$ or bleed$)).tw 3. ((hemorrhag$ or haemorrhag$) adj6 (stroke$ or apoplex$ or cerebral vasc$ or cerebrovasc$ or cva)).tw 4. (ICH or ICHs or PICH or PICHs).tw 5. 1 or 2 or 3 or 4 6. exp blood pressure/ 7. exp hypertension/ 8. (blood pressure or bloodpressure).tw 9. ((bp or blood pressure) adj5 (lowering or reduc$)).tw 10. ((strict$ or target$ or tight$ or intens$ or below) adj3 (blood pressure or systolic or diastolic or bp or level$)).tw 11. (hypertension or hypertensive).tw 12. ((manage$ or monitor$) adj3 (hypertension or blood pressure)).tw 13. ((intense or intensive or aggressive or accelerated or profound or radical or severe) adj5 ((bp or blood pressure) adj5 (lowering or reduc$ or decreas$ or decrement or dimin$ or declin$))).tw 14. ((standard or normal or ordinary or guideline or guide line or guideline recommend$ or recommend$ or convention$ or usual or established) adj5 ((bp or blood pressure) adj5 (lowering or reduc$ or decreas$ or decrement or dimin$ or declin$))).tw 15. (antihypertensive adj2 (agent$ or drug$ or medicat$)).tw 1 16. 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 17.
    [Show full text]
  • Get in Rhythm with the Safe and Effective Use of Antiarrythmic Drugs
    Get in Rhythm with the Safe and Effective Use of Antiarrythmic Drugs Karen J. McConnell, Pharm.D., FCCP, BCPS- AQ Cardiology, ASH-CHC Clinical Director and Cardiology Subject Matter Expert, Cardinal Health Clinical Associate Professor, University of Colorado Skaggs School of Pharmacy and Shannon W. Finks, Pharm.D., FCCP, BCPS- AQ Cardiology, ASH-CHC Professor of Clinical Pharmacy, University of Tennessee College of Pharmacy Clinical Specialist Cardiology, Veterans Affairs Medical Center Memphis Disclosure The program chair and presenters for this continuing education activity have reported no relevant financial relationships. Objectives . Design patient-specific treatment and monitoring plans for antiarrhythmic drugs (AADs) to treat atrial fibrillation (AF) . Differentiate among appropriate monitoring strategies for various agents used in ventricular arrhythmia suppression . Avoid potential adverse drug events with AADs by identifying important drug interactions . Ensure safe and effective dosing of AADs based upon specific patient factors Rhythm Rule #1 . Pharmacists play a vital role in the appropriate use of AAD dosing, adverse effects, interactions, and monitoring. Treatment and Monitoring of Atrial Fibrillation Atrial Fibrillation • Most common type of serious arrhythmia • In U.S., affects 2-5 million patients • Frequently seen with comorbidities • AF complicates management of comorbidity • Comorbidity complicates management of AF • Associated with stroke, heart failure, death • Most common arrhythmia requiring hospitalization Case #1: Mary Rhythm 60 y/o AA woman with a PMH including . Laboratory data: HFrEF (EF 35%), atrial fibrillation(AF), CKD, 140 110 18 HTN 105 . Inpatient Medications: 4.7 22 1.6 apixaban 5 mg twice daily lisinopril 20 mg daily BP 115/78 mm Hg HT 67 in metoprolol succinate 50 mg/day HR 70 bpm WT 75 kg furosemide 40 mg twice daily spironolactone 25 mg/day .
    [Show full text]
  • A Comparison of Intravenous Esmolol Versus Intravenous Diltiazem in Atrial Fibrillation with Rapid Ventricular Response-A Study from an Academic Center
    Cardiol Cardiovasc Med 2020; 4 (4): 450-459 DOI: 10.26502/fccm.92920143 Research Article A Comparison of Intravenous Esmolol versus Intravenous Diltiazem in Atrial Fibrillation with Rapid Ventricular Response-A Study from An Academic Center Manjari R Regmi1*, Mohammad Al-Akchar2, Bishal Bhandari1, Abdisamad M Ibrahim1, Priyanka Parajuli1, Odalys Estefania Lara Garcia1, Basma Al-Bast1, Nitin Tandan1, Ruby Maini1, Warren Alexander Skoza1, Marissa Kircher1, Abigail Levy1, Joseph Pflederer1, Brendan Finnell1, Albert Botchway1, Vivek Prakash1, Abhishek Kulkarni2, Momin Siddique2, Mohamed Labedi2 1Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA 2Division of Cardiology, Southern Illinois University School of Medicine, Springfield, IL, USA *Corresponding Authors: Manjari Rani Regmi, Southern Illinois University School of Medicine, 701 North First Street, PO Box 19636, Springfield, IL 62794-9636, USA, Tel: 217-545-0193; F a x : 279-201-6023; E-m a i l : [email protected] Received: 03 August 2020; Accepted: 15 August 2020; Published: 26 August 2020 Citation: Manjari R Regmi, Mohammad Al-Akchar, Bishal Bhandari, Abdisamad M Ibrahim, Priyanka Parajuli, Odalys Estefania Lara Garcia, Basma Al-Bast, Nitin Tandan, Ruby Maini, Warren Alexander Skoza, Marissa Kircher, Abigail Levy, Joseph Pflederer, Brendan Finnell, Albert Botchway, Vivek Prakash, Abhishek Kulkarni, Momin Siddique, Mohamed Labedi. A Comparison of Intravenous Esmolol versus Intravenous Diltiazem in Atrial Fibrillation with Rapid Ventricular Response-A Study from An Academic Center. Cardiology and Cardiovascular Medicine 4 (2020): 450-459. Abstract Introduction: This study’s objective was to compare Methods: The measured parameters were the number of the differences in the effects of intravenous esmolol and hospital re-admissions, length of hospital stay, time diltiazem on patients having atrial fibrillation with taken for rate control, and side effects like hypotension RVR.
    [Show full text]
  • The Effect of Intraoperative Lidocaine Versus Esmolol Infusion On
    Bajracharya et al. BMC Anesthesiology (2019) 19:198 https://doi.org/10.1186/s12871-019-0874-8 RESEARCH ARTICLE Open Access The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial Joshan Lal Bajracharya1, Asish Subedi2* , Krishna Pokharel3 and Balkrishna Bhattarai4 Abstract Background: As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy. Methods: In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5– 15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively. Results: Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27).
    [Show full text]
  • Ep 2444077 A1
    (19) & (11) EP 2 444 077 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.: 25.04.2012 Bulletin 2012/17 A61K 31/00 (2006.01) A61K 31/215 (2006.01) A61P 3/10 (2006.01) (21) Application number: 12151969.8 (22) Date of filing: 24.01.2008 (84) Designated Contracting States: • Gollapudy, Reena, R. AT BE BG CH CY CZ DE DK EE ES FI FR GB GR 411 045 PUNE (IN) HR HU IE IS IT LI LT LU LV MC MT NL NO PL PT • Deshpande, Supreet, K. RO SE SI SK TR 411 045 PUNE (IN) (30) Priority: 29.01.2007 IN MU19602007 (74) Representative: Ahner, Francis et al Cabinet Regimbeau (62) Document number(s) of the earlier application(s) in 20, rue de Chazelles accordance with Art. 76 EPC: 75847 Paris Cedex 17 (FR) 08720107.5 / 2 114 386 Remarks: (71) Applicant: Vlife Sciences Technologies Pvt Ltd. This application was filed on 20-01-2012 as a Pune 411 045, Maharashtra (IN) divisional application to the application mentioned under INID code 62. (72) Inventors: • Kulkarni, Sudhir, A. 411 045 PUNE (IN) (54) Pharmaceutical composition for treatment of diabetic complications (57) A method for treating diabetic complications by abetic complications, such as diabetic wounds, are dis- administration of a beta-blocker is disclosed. Diabetic closed. The present invention includes employing a top- complications arise from diabetes and have few or no ical formulation of a beta- blocker, having substantially no existing treatment options. The present invention de- antibacterial activity, to improve the process of diabetic scribes the use of a beta-blocker in the treatment of a wound healing.
    [Show full text]